Inflammatory cutaneous lesions in inflammatory bowel disease treated with Vedolizumab or Ustekinumab: an ECCO CONFER multicentre case series

This was a multicentre case series supported by the European Crohn's and Colitis Organisation (ECCO) and, performed as part of the Collaborative Network of Exceptionally Rare case reports (CONFER) project. The aim was to report on whether cutaneous lesions associated with inflammatory bowel disease (IBD) and refractory to standard medical therapy including anti-TNFs, would respond to the newer biologic agents Ustekinumab (UST) or Vedolizumab (VDZ). This report includes 28 patients with cutaneous lesions form 14 centres, all of whom had failed immunomodulator and anti-TNF therapy. Metastatic Crohn's disease (MCD) was diagnosed in 10 patients: UST led to remission in 5 cases and partial response in 4 cases, with a single report of VDZ inducing remission. All cases of MCD treated with UST responded after the first or second dose, whilst the median time for the 5 cases that attained remission was 5 months. Pyoderma gangrenosum (PG) was diagnosed in 4 cases: 3 of these attained remission with UST (median time to remission 4 months) whilst one case did not respond to VDZ. There were 7 cases of erythema nodosum (EN): UST led to remission in 4 cases and partial response in 1 case whilst VDZ had partial response in 2 cases and non-response in 2 cases. There were 7 single cases of other inflammatory lesions. In summary, UST appears to be useful for different cutaneous lesions including MCD, PG and EN, whilst VDZ does not appear to be useful for lesions that are independent of disease activity.